Health Train Express Slows down

Quote of the day:
Don't worry about the world coming to an end today. It's already tomorrow in Australia. - Charles M. Schulz

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The Wall Street Journal today reported that the annual increase in employer based health insurance premiums increased by only 5% in 2007/2008.  This data came from the annual report of the Employee Health Benefits Survey, published each year.  This is a one source reference which covers a wide range of topics.

The  Bill of Health, a source for viewing an overall graphic of the state of our health system, and it's histor, "how we got here from there", produced by "Good", an internet site.The data for this graphic was obtained from these sources:

CIA World Factbook, Congressional Budget Office,Emanuel Heritage Foundation, Kaiser Family Foundation,National Center for Health Statistics,U.S. Census Bureau, Department of Health and Human Services, World Health Organization.

Health Train Bailout

Quote of the day:

No man's life, liberty or property are safe while the legislature is in session. - Judge Gideon J. Tucker

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Many blogs this week have turned their attention to the 'dire news' about our economy.  Although it is attributed to the 'meltdown' in the subprime mortgage market we all have a pretty good idea this is not the case.  It may have been the straw that  broke the camel's back , however we have had serious debt problems for many many years.

At the outset I receive at least two credit card offers each week. ( I have not used a credit card for six or seven years. My first medical practice nearly was bankrupted by numerous payors who without much warning reduced reimbursements by 40%, and also quite effectively stole my patient base in the name of managed care. At least four IPAs that I joined and sponsored went belly up in the same time period.  This devastated my long term and short term capitalization and business plan for my ophthalmology practice.

I had a rather nice home which I purchased, but could no longer afford the payments on. I sold it. There was no one there to offer me a bailout.

I had made some foolish decisions thinking that my high income would continue for many more years.  I also assumed nothing bad would happen to my health.  Boy, was I wrong, in both cases.  It was rather humiliating, at the time, and still carries a sting of shame.

I bring this up because I do not see any shame or humiliation in the officials who knew this was coming for some time.  Obviously they hoped they could make it through the first Tuesday in November.

Our nation is how many trillions of dollars in debt...All those hummers,mercedes, lexuses, and million dollar homes...As a nation we have become dead-beats.  Not the vision our founding fathers envisioned for a new country.

In 2001 we were attacked, and had a knee-jerk reaction entering a war that is still ongoing.

That has cost billions and billions of dollars.  It's easy to look back and judge if it was a mistake. At the time it was do it, or we would be wiped off the globe by terrorists.

 

We were told if we did not do it, the consequences would be dire. Now we are being told the same thing will destroy our economy regarding the 700 billion dollar bailout for the incompetency of some supposedly very bright financiers.

Listen up now....our economy is a wreck,

and bailout will do nothing to improve it.  Printing and finding 700 billion dollars

from some undisclosed source is not an option.  I'm not ponying up additional taxes to bailout some high and fancy financier that cooks books, manipulates markets, commits fraud, and exhibit no fiduciary responsibility for investors, and mortgage holder.

Back in the good old days, when banks were in trouble, they recalled loans, mortgages if their reserves became inadequate. I don't know if they do that anymore.

We have been told for many years that Social Security and/or Medicare would be bankrupt by 2013....The feds were setting us up to blame it on medicine, patients, hospitals....All the while the financial system was already in the tank.  How come no one predicted this one?

We thought Enron, Worldcomm, Charles Keating, and the Savings and Loans fiasco some 15 years ago was bad....you ain't seen nothing yet....As Yogi Berra says, "it ain't over 'til it's over."

Health Train----continued

Last visit I was pontificating about the financial underpinnings of the financial markets and the parallel aspects of healthcare.

One of the most compelling reasons for not adopting a universal payor system  is that it mimic many negative aspects of the federal government....increased regulatory mechanisms, inertia,inbred obsolence, guarranteed employment for civil servants regardless of their "outcomes" and payment for non-performance.

Do you want all that  power and authority placed in the hands of one, or several governmental officials??

(L-R)  The financial 'rainmakers"

Fed Reserve Chairman Bernake & Senator Tom Dodd, Chairman of the Senate Financial Oversight Committee.

All these 'trusted public servants' should be more than disciplined, and perhaps fired.

Imagine now this is the  Federal Health Care Reserve Board.

We already hear  the "blame game"....where were these folks? And where was the United States Congress? There are a litany of excuses..

!!Keep these people out making  health care decisions!

Health financing = f (financial markets)

Post revised 09/22

Quote of the day:
Where humor is concerned there are no standards - no one can say what is good or bad, although you can be sure that everyone will. - John Kenneth Galbraith

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While health care issues are still important, this week's pop quiz has switched to fundamental finance market dysfunction and chaos.  Sound familar?  We in medicine do not have a monopoly on that.  The diagram above relates the increasing mortgage foreclosure rate and the lower red line the decrease in the mortgage financial index.....We could equate this graphic display  to increasing health care utilization vs decreasing reimbursement.  Perhaps some of these financial wizards and tycoons will be applying to medical school as a second career, and we can take over their positions.

The new links over there on the left side will take you to a number of podcasts. 

Universal Payor continues to be promoted by the Obama camp.

My previous post was relatively benign in regard to "nationalizing" our health care financing. However, as the crisis in the 'financial markets' continues to deepen, and our "financial experts"  juggle to make sense of and correct for man's greed, this is a lesson in what not to do. 

Perhaps on the one hand the size of the federal government, and it's ability to print money a la carte gives reassurance to some.

The "Federal government is....large, burdensome, and once set in motion has great inertia and is difficult to steer, or stop. In fact Treasure Secretary Paulson stated that the "Fed" had failed  to adapt to the new global economy and the regulatory mechanism was obsolete.

There are eighty boxes in the organizational chart of the Treasury Department.

Universal payor also embellishes the same risks. A great deal of power in one place, unable to adjust to changing markets, or technology. One of the reasons the United States still fundamentally has the best health science is because of it's entrepenurial bent. The best science and translational science is not the same as the best healthcare.......to be continued

Health Train Design

I am in the midst of restructuring the blog. You may have noticed an increase in the amount of graphics and related links to other sites.  In my mind blogging allows one to freely associate, and click here and there....it is always a surprise where it will take you.   This requires the kind of mind that multi-tasks, and it may be an advantage to be somewhat bipolar.....

Health Train Brain Drain

Quote of the day:
'Tis better to be silent and be thought a fool, than to speak and remove all doubt. - Abraham Lincoln

 

Now and then Matt Holt will   publish opinions and revelations that are truly 'aha' and are 'I thought of that, why didn't I write it?

True to this idea were the latest comments on his blog, THCB.    Uwe Reinhardt, who is well known in health care policymakers circles, authored a report for New Jersey Governor Tom Corzine

(photo is clickable,, for details)

regarding the state of health care in New Jersey.

The bottom line of this report, which Governor Corzine asked not be published was " Who in their right mind would design a healthcare system revolving around employment? Enthoven and Fuchs  (Health Aff (Millwood). 2006 Nov-Dec;25(6):1538-47), review the rapid growth of plans for the 3 decades following world war II, their peak and decline in the 1980s.

Where's My Wallet?

Quote of the day:
A good listener is a good talker with a sore throat. - Katharine Whitehorn

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Anyone who comes out of the operating room, or hospital is greeted by news of the collapse of the financial markets, and the nationalization of  investment banking, real estate markets, and other institutions.  These large institutions seem distant and not related to our daily lives, however their 'greatness' has been built from the ground up.

Will the same occur to health care....is universal payor really a politically correct synonym for "socialized medicine"?  Of course it is.....

Federal government 'bailouts', emergency loans and subsidies which are capitalized by printing money, fancy terms such as

In brief formal remarks outside the Oval Office, Bush sought to show that the administration is moving swiftly and aggressively by taking "extraordinary measures."

     are all going to be paid by you....the taxpayer. In addition our dollar valuation has collapsed....only supported by   infusions of more imaginary financing from undisclosed printing presses.

The really frightening aspect of this scenario are the things that are occuring now, behind the scenes, the news of which is suppressed and not disclosed.

A year ago we were hearing how fundamentally 'sound' our economy is despite the housing bubble and implosion. 

Voodo economists can graph just about anything. This

graph represents that the cost of gasoline actually has not increased. Sure, tell that to my wallet!!!

 

Perhaps the "no child left behind" act should have been extended to congress and the administration.  Obviously they cannot do math, or think intelligently. 

In health care we have become "victims"

despite our  proactive, take charge and take responsibilty for our actions drummed

into all of us and  which  at least was ingrained in me during my education and training.

The "thinkers" at the highest level have approached the looming healthcare crisis as controlling costs.  They looked at the total cost of health care, and related it to GDP.  In actuality this is not what they did. They controlled reimbursements, not  costs

Costs to the provider, and hospitals have actually soared due to inflation and the change in demographics..  Providers did a great deal of creative and innovative changing, developing, IPAs, PPOs, even the dreaded "mangled care" models.  This however is a bit like dealing with 'imaginary numbers' such as the square root of minus one.  The calculus of all this is quite imaginary as well.

Politicians know full well that they will be gone in four to eight years (if they are lucky), and will leave the 'mess' to the next "I can fix it"   

McCain  " Don't leave me"   Bush, "It's okay Johnny, just get your hand off my crotch"    Bush, "I'm going to be unemployed, where's my COBRA?"

Aside from all this gloom and doom, on the horizon as the sun sets, and the moon rises in the east is the new "Consumer Driven" Health Care model

From the Piper Report

Any relationship between this and going in circles is accidental, and the reader should discount any suggestion that this is a circle.

It would all be so funny, if it were not true....

Live, from New York...it's Saturday night!!!!!

Which one of us should meet with Sarah Palin?

Focus numero uno

Quote of the day:
Perhaps in time the so-called Dark Ages will be thought of as including our own. - Georg Christoph Lichtenberg

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In my last post I began to ask where do we focus? Can we reform the entire health system at once?

I was not quite sure where to go from there, but in the  process of researching for today's article I came across an email from Greg Scandlen, who is affiliated with the Heartland Institute and Consumers for Health Care  Choices.

Patrick Rooney

Click on Photo for Newspaper Article

who is credited with the original idea of medical savings accounts (renamed health saving accounts), recently passed away, but was given a "lifetime achievement award" for his dedication to improving the lot of the disadvantaged.  Here is the program from that award ceremony.

Patrick Rooney Award

Mr. Rooney's bottom line was that he does not want to see health insurers and hospitals 'screwing the consumer'.  Sounds good to me....now how about the physicians???

From my perspective we should all realize our patients are on our side and we must remain their advocates and not allow intermediaries, nor government to divide us in giving and receiving health care.

Health Care Reform, Where to Focus

Start the video for some 'listening music' whilst you read today' offerings.

Quote of the day:
One of the first duties of the physician is to educate the masses not to take medicine. - Sir William Osler

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Steven Beller, PhD  has been blogging for over five years. His recent blog contribution at Curing Health reveals some important clues to where our resources should go in reforming our health care system. He and I became involved in what was probably one of the first blogs, Trusted.MD, started by Dimitriy Krygylak.  That was a time when I was really interested in RHIOs and the implementation of EMRs.

We need a quality Health Train, one that can efficiently carry as many passengers as possible,

and not leave patients at the train station, waiting and hoping for the next express.  When they get on the train we want them to have a safe and relatively good experience in a time when they are ill.  Additional stresses beyond getting well should not be in their path on that goal.

The buzz word for the last two or three  years has been Health 2.0. Heralded as the next "Apple" of the internet it has found some acceptance, but the business model remains weak, except for some focused applications such as .asp solutions for medical management and electronic medical records and personal health records.  In reality .asp has been around for decades since the days of mainframes.  Today's applications are being directed at patients, and consumers.  Steve Case and Revolution Health have been disappointed in their venture for our 'vision' for the future. Well intentioned, Steve Case invested a good portion of his well deserved treasury from American Online.  Revolution Health is now for sale, having been unable to establish a business model with sustainable income.  This should be a loud example that pouring large amounts of money into an idea does not always bear fruit.  Steve should not be faulted...he is not the first, nor the last to go down that path.  Sound familiar? A lot like RHIOs.

And that's the rest of the story.

PRO(TECH)T Act of 2008

Quote of the day:

 
Boys will be boys, and so will a lot of middle-aged men. - Kin Hubbard

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The role of the Federal Government rears it's head  once again

with the reactivation of H.R. 6357, as it winds it's way through the Ways and Means Committee chaired by our venerable and staunch representative, and defender of the coiffers of HCFA, Pete Stark of California.

Elements of the draft bill call for:

• Maintaining the grant and loan programs included in HR 6357;
• Directing federal officials to coordinate the development of an open source electronic health record;
• Establishing Medicare incentive payments for health care providers who adopt and use IT systems;
• Requiring federal officials to study the definition of "health care operations" to determine which activities can be performed with de-identified data and which need patient consent;
• Preserving most of HR 6357's security and privacy provisions but specifying that the accounting requirement only would apply to disclosure of information stored in EHR systems;
• Increasing penalties for HIPAA privacy rule violations and requiring a Government Accountability Office study on the "minimum necessary" standard for disclosing data; and
• Authorizing state attorneys general to file lawsuits to enforce the privacy rule.

A quick observation on my part in reviewing the list of  CCHIT certified software reveals the certified solutions are quickly gaining ground in the market place. Primary care is on the leading edge of  EMR in software applications and will be as the concept of a  "Medical Home"  gains it's foothold.

THE  MEDICAL  HOME...KEY TO THE PUZZLE??

Sometimes I just want to 'Scream'

Metrolink Express

Quote of the day:
He's turned his life around. He used to be depressed and miserable. Now he's miserable and depressed. - David Frost

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On a Sunday morning, instead of picking up the newspaper (as my father once did) I read through my feeds and blogs

Tragedy abounded this weekend.  First in the Gulf area another act of nature, the third major event transformed lives in an instant into chaos and life altering change.  In California a commuter train rounded the bend and ran smack into a freight train. 

I think there are strong parallels in these two events. The Health Train Express is rounding the bend and it will miss the switch and run head on into failure, and certain death for many of the passengers.  The failure of the train pales in the face of the deaths of the passengers, for certainly that would follow in health care.

Nature's fury and the law's of physics overruled the hardiness and downright stupidity of those who remained behind on the gulf coast. 

Denial is a powerful psychological mechanism which can lead to  poor health, or death just as it did during Ike. 

In my next  posting I will return to commentary and late news about events in health IT, the original focus of Health Train Express.

Gloom and Doom

Health reform is not an easy task. If it was it already  would have been accomplished, or at least begun.

The recent financial disasters,including bank failures in the wake of the subprime mortgage market fiasco and secondary consequences in it's wake now have impacted investor firms, and banks.  Even the backup organizations are being threatened and choices must now be made as to which institutions can or will be saved.  In any case you and I will pay for these events, regardless of who is at fault.

Our medical care system has not been immune from this instabilty, nor will it be now and in the future. There is a strong parallel in medical care.  Financial institutions have felt some level of protection by governmental safety-nets.  (Sound familar?)

Our health care financing system and insurers have had the ability to maintain profitabilty and sustainability by their ability to carve out profit each year by forcibly reducing their reimbursement to those providing the actual care, without concern for rising cost, nor deterioration of   care.  The safety nets of medicare and medi-cal are now stressed to the maximum.

Further statements of insurance coverage now belie the fact that even those with "insurance" are not covered. Many providers now are not accepting medicare and many more do not accept medi-caid.  Patients who "have" medicaid are in fact unable to find providers who will see them.  The recent budgetary crisis in California has now totally placed all medi-cal payments on hold.

Tens of thousands of patients in skilled nursing facilities are about to be 'evicted' since their  'homes" will be closed and shuttered.

Costs are being shifted by the surge of non covered patients on medi-cal to private payors because the hospitals have to offset these losses.

There is no doubt that patients are suffering and even dying. More will die if further cuts occur.

Health Train Express Weather Report

Quote of the day:
In the land of the blind, the one-eyed man is stoned to death. - Joan D. Vinge

 

Our health train travels along on it's rails but may be battered or damaged by inclement weather, earthquakes, tsunamis or other uncontrollable factors.

Such an event may be occuring in the U.S. economy. More bad news today about Lehman Brothers, which follows on the heels of Bear Stearns takeover by JP Morgan, and the failure of Fannie Mae, and Freddie Mac which has all been attributed to the subprime mortgage fiasco. And there are rumblings about WAMU as well.

Nevertheless the present U.S. administration insists that our economy is basically sound....FOR WHO? Certainly not for the majority of Americans, nor their physicians.

My previous post regarding a "Health Train" bailout was a fictitious accounting of what would happen to the healthcare market, were the same rules applied to it as the financial markets and general economy. 

I only wish we could be "taken over". (not really)  Nevertheless we seem to be driven close to that feeling of wanting to get "it" off our backs as physicians, and that does not pertain only to the financial responsibilities for operating our practices, both large or small.

What does the catastrophic financial failure mean?

1. In the first instance it threatens many retirement investment accounts, and if your firm is not involved it at leasts makes  you very nervous about your holdings.  (where does all this money go?  Does market value really reflect the value of products produced by companies as they appear on the stock exchanges?  If the experts cannot predict what is going on,and I think they can, but withold information so as not to depress the market further and cause panic.

2. The depression of the markets  carries over to the holdings of insurance companies, and capital markets upon which major hospital construction and operating expenses depend.

3. Short term and long term credit has constricted to the point where capital is not available to most borrowers, especially to  younger physicians who are heavily in debt just from medical school loans.  Most physicians are in a negative net worth situation for the initial five to ten years of practice.

This very much effects the ability for new providers to migrate to underserved, or rural areas, without some form of support by a hospital or community.

The consolidation of the banking industry also effects the ability to obtain local credit, unless the health care borrower seeks credit from a local community source, deeply involved in a local community that shares the need to see healthcare services continue.

..............In my next blog I will review the history of present events and what corporatization has done to your medical care.